Dr Timothy Yeoh | Shoulder and Knee Orthopaedic Surgeon

KNEE ARTHRITIS

admin — Wed, 25 Nov 2020 08:59:26 +0000

What is Knee Arthritis?

Knee arthritis is a disease where the cartilage lining of the knee wears away, and bone starts to grind against bone. This can be extremely painful, and can also be associated with other symptoms like clicking sounds, catching of the knee, and recurrent swelling. It usually comes on gradually over many years and can often run in families. This degenerative type of arthritis is called ‘osteoarthritis’ and is the most common. Other types of arthritis are less common but equally troublesome such as Rheumatoid or Inflammatory Arthritis, Crystalline Arthritis (associated with gout or pseudogout) or post-traumatic arthritis where someone has had a prior injury to the knee and has now developed arthritis.

How is Knee Arthritis diagnosed?

Often all it takes to diagnose knee arthritis is for a medical professional to look at your knee, examine it, and get an X-Ray. Nevertheless, sometimes things are not so straight forward, and further investigations like blood tests and MRI scans are needed.

Can knee damage be reversed?

Unfortunately once the cartilage has started wearing away, there is nothing that we know of yet that can stop this. It’s an irreversible disease, but everyone progresses at different rates. It is pretty common for people to have arthritis for many years before they even know about it.

What can be done to ease knee pain?

Luckily there are lots of things that can ease knee pain due to arthritis. The best thing to do is to keep active with sports that do not involve repeated high impact to your knees. Things like cycling, rowing, swimming and Tai Chi can all be useful in keeping your knee healthy and minimising pain. Structured physiotherapy in the form of land-based activities as well as hydrotherapy has been proven to decrease knee pain. Minimising any excess weight that you might be carrying will also help. The best thing about all these ideas is that they do not involve any herbal remedies, medications or operations. Pain-relieving medications and injections can help if you find that sensible exercise is not helping. Remember, knee pain due to arthritis is extremely common, and there are lots of ‘remedies’ that are being advertised to minimise this. Many have been proven to not work, and many have no scientific evidence for them at all. There are so many options out there that The Royal Australian College of General Practitioners has even published some detailed guidelines to help all medical professionals know what to recommend and what not to recommend. This was last updated only two years ago!

I’ve tried all that, but my knees still hurt. Is there anything else that can help?

If you have seen your local doctor and physiotherapist, tried all their recommendations and still have significant pain that is affecting your quality of life, it may be time for a visit to an orthopaedic surgeon. The last available treatment for knee arthritis is to have a knee replacement, where the arthritic portions of the knee are cut out and replaced with metal and plastic. In general, this is a very successful operation at returning people to function, and minimising pain. A knee replacement has a satisfaction rate of around 85%, which in itself is fantastic, but the hunt is on for that last 15%. In Australia, we are so lucky to have excellent health care, and surgeons can use technology to try to get that perfect knee for you. This can be achieved in many different ways – for example – using computer navigation, personalised 3D printed moulds or even using a robot. If you do end up seeing an orthopaedic surgeon, make sure you ask them what their preference is and why!

SPRING SPORTING INJURIES

admin — Tue, 29 Sep 2020 07:01:34 +0000

Perhaps you’re worried about a sudden onset of symptoms in your shoulder, and you’re asking yourself some of these questions;

When I follow through on the golf course, why am I experiencing sharp pain in my shoulder joint?

Why is my shoulder catching and feeling stiff during my service motion when playing tennis?

I have a persistent dull ache in my shoulder and down my biceps at night, is this normal?

Will I be able to return to my sport if my injury requires surgery?

Injuries to the shoulder can be due to repeated overuse of the joint or through acute traumatic injuries such as fractures, acute rotator cuff tears or shoulder dislocations. Whichever way the damage has occurred, it can be excruciating and severely affect your level of activity and performance.

The shoulder joint is very mobile, with the ability to move the most of any joint in the body. To achieve this incredible movement, there is teamwork between many ligaments and muscles that work in unison and maintain stability.

Injuries can occur in any number of these structures, including tears of the rotator cuff tendons, biceps tendon, or the cartilage ring around the shoulder called the labrum. The picture below gives you an insight into where these sit in the shoulder.

The most common Sporting shoulder injuries and symptoms associated with these are:

Rotator Cuff Tears
- These cause pain in the shoulder and weakness. It is often painful to elevate the arm.
Labral tears – either at the top (SLAP tears) or associated with shoulder instability/
- These can cause pain in the shoulder and also down the biceps region. Sometimes you can feel like your shoulder is very unstable and will pop out if not careful.
Shoulder impingement/bursitis
- This is usually assosicated with pain when reaching up overhead
Shoulder dislocation
- This is when the shoulder joint pops out and can remain unstable
Fractures of the shoulder or clavicle

You may be asking yourself; how do I know if my injury is just a strain/sprain or if it’s something more sinister?

This can be tricky to work out. If you know you have dislocated your shoulder or experienced an acute injury such as a fracture or you cannot move your shoulder at all, you should seek medical advice straight away. If the injury is something more subtle and you can still move the shoulder even though it is painful, then give it a week to settle.

If it doesn’t get any better, then be sure to make an appointment with your physiotherapist or local GP for investigation, and you may be referred to an orthopaedic surgeon for review.

Many people are unsure if they should visit a GP, physio, sports physician or an orthopaedic specialist.

My advice would be that when it comes to shoulder sporting injuries, a good physio or sports physician is key!

Lots of conditions in the shoulder respond well without the need for surgery.

Almost all shoulder injuries will need some imaging such as an X-Ray, MRI or CT to figure out what the cause of your problem is, and this can be where an orthopaedic surgeon will support you in helping to order appropriate investigations and reviewing the imaging to confirm if there is a tear within the shoulder. If there is a problem – be it rotator cuff or labrum, or something else – then your surgeon and physio will work closely together to figure out a way to get you back to your best performance.

PAIN at the BACK OF THE KNEE

admin — Wed, 16 Sep 2020 05:20:17 +0000

Why does my knee hurt after exercise?

There are lots of reasons why your knee may hurt after exercise, and sometimes it can be quite difficult to pinpoint. A good place to start is where exactly the knee is sore. Most commonly in runners and jumpers, the knee can hurt at the front which might suggest a patella tendon, quads tendon or patella cartilage issue. If the knee hurts on the sides, it could be a ligament or meniscus tear, or even arthritis. If the knee hurts at the back, then sometimes this could be muscle or tendon tears, or a Baker’s cyst.

What exercises are good for my knee?

Exercises that keep your knee strong, whilst minimising impact are the best for you knee. Rowing, cycling and swimming are great knee exercises. Squats, leg press and knee extensions can be modified if they hurt to not dip too deep whilst still keeping the muscles around the knee strong which are essential for knee health. Sadly, running and jumping are not great for knees in general, as these cause high, repeated impacts to the structures of the knees which can injure them.

My knee hurts! Now what?

Pain and swelling is not good, and you should try to rest the knee. Elevate the knee, ice it, and try some compression bandages. Take a break from that particular exercise while the knee is sore, and try again a week later. If it has not improved in a week, then you should seek the advice of your local doctor or physiotherapist.

What things should I watch out for?

Marked swelling, new onset clicking, locking or the knee giving way, as well as a feeling of instability are all things of concern, and professional help should be sought earlier rather than later. Your health professional may decide to send you for an MRI scan which can help diagnose your problem.

Do I need to see an orthopaedic surgeon?

Not all injuries require you to see an orthopaedic surgeon. Be guided by your physiotherapist and your local doctor. Some injuries like muscle and tendon sprains or degeneration are treated very effectively by physiotherapists and sports physicians. Other things like ligament tears, such as an ACL tear, or meniscus tears would benefit from a visit to an orthopaedic surgeon for an opinion.